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General NPI Number Information
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NPI Number | 1124567383
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Entity Type | Individual
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Provider Name | DEMI PHAM SHIMIZU DDS
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Gender | Female
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 2050 JUDAH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-1531
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Country | US
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Telephone | 415-681-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1763 FOXWORTHY AVE
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City | SAN JOSE
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State | CA
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Zip | 95124-2406
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Country | US
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Telephone | 408-887-2499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 103692
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License Number State | CA
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